A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

telehealth - Top 30 Publications

Reliability of Lagged Poincaré Plot parameters in ultra-short Heart Rate Variability series: Application on Affective Sounds.

The number of studies about ultra-short cardiovascular time series is increasing because of the demand for mobile applications in telemedicine and e-health monitoring. However, the current literature still needs a proper validation of heartbeat nonlinear dynamics assessment from ultra-short time series. This paper reports on the reliability of the Lagged Poincaré Plot (LPP) parameters - calculated from ultra-short cardiovascular time series. Reliability is studied on simulated as well as on real RR series. Simulated RR series are generated and LPP parameters estimated for ultra-short time series (from 15 to 60 s) are compared to those estimated from 1 hour. All LPP parameters estimated from time series longer than 35 s presented a Spearman's correlation coefficient higher than 0.99. RR series acquired from 32 healthy subjects during 5-minutes resting state sessions are used to test the LPP approach in experimental data. The usefulness of ultra short term parameters in real data is accomplished also studying their ability to discriminate positive and negative valence of auditory stimuli taken from the International Affective Digitized Sound System (IADS) dataset. The achieved accuracies in the recognition of elicitation along the valence dimension, using only the LPP parameters, were of 77.78% for 1 minute 28 second series, and of 79.17% for 35 second series.

Intercontinental telehealth coaching of therapists to improve verbalizations by children with autism.

This study examined the effects of intercontinental telehealth coaching on the mastery of therapists' skills and improvements in verbalizations by children with autism, testing whether telehealth can be a solution for underserved communities in developing countries such as Georgia-Sakartvelo in Eastern Europe. Three therapists delivering and three children with autism receiving early-intervention services from the nongovernmental organization Children of Georgia in Tbilisi participated. Experimenters provided coaching from Virginia, USA to therapists in Georgia-Sakartvelo. Observers in Georgia-Sakartvelo and in Virginia conducted the behavioral observations. We used inexpensive communications technology to provide the coaching and a multiple-baseline design across participants to evaluate the effects of the intervention. Therapists demonstrated improvements in two classes of behaviors: correct command sequences and positive consequences. The children demonstrated improvements with echoics and mands. The study demonstrated that telehealth can be a good model for delivering early-intervention services to children with autism in underserved and distant regions of the world.

Real-time teleophthalmology video consultation: an analysis of patient satisfaction in rural Western Australia.

Teleophthalmology, particularly real-time video consultation, holds great potential in Australia and similar countries worldwide, where geography, population and medical workforce distribution make it difficult to provide specialist eye services outside of major cities. Assessment and referrals from rural optometrists are vital to the success of teleophthalmology. While there is good evidence for the efficacy of such services, there is limited evidence for patient satisfaction with video consultation.

Academic and private practice partnerships in veterinary radiology residency training.

As veterinary radiologists devote greater time to telemedicine consultation, residency training must evolve to reflect the skills of these services. The contribution of private practice/consultant radiologists to residency training has traditionally been minimal but academic and private practice partnerships in education and research can provide the framework for a well-rounded residency. These partnerships can also lessen the impact of workforce shortages in academia and provide financial compensation to academicians through external consultation. The purpose of this commentary is to review existing collaborative interactions between academic and private practice veterinary radiologists; with a focus on ways to sustain, improve, and cautiously increase the number of veterinary radiology training programs.

Real-time individualization of the unified model of performance.

Existing mathematical models for predicting neurobehavioural performance are not suited for mobile computing platforms because they cannot adapt model parameters automatically in real time to reflect individual differences in the effects of sleep loss. We used an extended Kalman filter to develop a computationally efficient algorithm that continually adapts the parameters of the recently developed Unified Model of Performance (UMP) to an individual. The algorithm accomplishes this in real time as new performance data for the individual become available. We assessed the algorithm's performance by simulating real-time model individualization for 18 subjects subjected to 64 h of total sleep deprivation (TSD) and 7 days of chronic sleep restriction (CSR) with 3 h of time in bed per night, using psychomotor vigilance task (PVT) data collected every 2 h during wakefulness. This UMP individualization process produced parameter estimates that progressively approached the solution produced by a post-hoc fitting of model parameters using all data. The minimum number of PVT measurements needed to individualize the model parameters depended upon the type of sleep-loss challenge, with ~30 required for TSD and ~70 for CSR. However, model individualization depended upon the overall duration of data collection, yielding increasingly accurate model parameters with greater number of days. Interestingly, reducing the PVT sampling frequency by a factor of two did not notably hamper model individualization. The proposed algorithm facilitates real-time learning of an individual's trait-like responses to sleep loss and enables the development of individualized performance prediction models for use in a mobile computing platform.

Establishing Successful Patient-Centered Medical Homes in Rural Hawai'i: Three Strategies to Consider.

The challenges to healthcare delivery posed by Hawai'i's unique geography, physician shortages, and dispersed population are of particular importance in light of implementing the Affordable Care Act (ACA). This study draws on central goals laid out in the ACA - to decrease costs, increase access, and improve patient outcomes. The use of the Patient-Centered Medical Homes (PCMHs) is a care model that has the potential to meet all three goals. How to identify the most effective way to develop PCMHs in the specific context of Hawai'i is the focus of this study. To provide recommendations for effective PCMH formation, a qualitative review of previously compiled data from the Hawai'i/Pacific Basin Area Health Education Center (AHEC) and phone interviews with six primary care providers throughout the islands were conducted. The results broadly suggest three paths towards the effective implementation of PCMHs in Hawai'i. The first recommendation is to create a PCMH template or business model for physicians in order to ease the complexities of implementing such an elaborate system of care. The second two recommendations actually veer away from PCMH towards general interventions to increase care in rural Hawai'i. Thus, the second recommendation is to create a specific track for becoming a rural practitioner at the John A. Burns School of Medicine (JABSOM) to increase the retention of physicians in underserved areas. And the final recommendation is to increase utilization of telemedicine techniques to overcome physician shortages and geographic challenges by allowing rural physicians to network with specialists on neighbor islands. These three strategies are all possible to accomplish with commitment and could be implemented to benefit the providers and rural population of Hawai'i.

Hawai'i Physician Workforce Assessment 2016: Improvement in Physician Numbers but Physician Suicides of Concern.

Hawai'i's Physician Workforce Assessment project was launched in 2010. Over the past 5 years the State has experienced decreases and increases in physician workforce. This current article describes the status of the physician workforce, past trends and anticipated projections as well as recent insights into why people leave Hawai'i. Survey data, internet searches and direct dialing methodologies were utilized to clarify and elucidate practice location, full time equivalency of time providing patient care and specialty of non-military physicians caring for Hawai'i's population. A proprietary microsimulation modeling methodology from the company the US Health Resources and Services Administration employs is utilized to assess demand. The current shortage of physicians is estimated to be between 455 and 707 full time equivalents with the greatest percentage of shortages on neighbor islands. Numerically the greatest total shortage of physicians is on O'ahu and the specialty in greatest demand is primary care with a shortage of 228 Full Time Equivalents (FTEs). Physician average age in Hawai'i is 54.9 compared to a national average of 51. There was an increase in the number of physicians who report using telehealth, from 2% to 15%. Initial improvements in the size of Hawai'i's physician workforce are promising, but we note two reported suicides in the intervening year. More attention must be paid to support practicing physicians in addition to our efforts to recruit new physicians.

Development of School-Based Asthma Management Programs in Rochester, NY.

In the spirit of Dr. Haggerty's teachings, we present an overview of our work to improve care for children with asthma in the context of 3 lessons learned:(1) 1) The importance of providing integrated services across disciplinary boundaries for children with chronic illness, 2) The need to move from a care model focused only on the individual child to a model focused on the child, family, and community, and 3) The need to expand beyond the local community and take a broad perspective on improving health on a national level. The goal of our program is to develop sustainable models to overcome the multiple obstacles to effective preventive care for urban children with asthma. The primary intervention for our original School Based Asthma Therapy (SBAT) program was directly observed administration of preventive asthma medications in school (with dose adjustments based on NHLBI guidelines).(2) We found that children who received preventive medications in school through directly observed therapy had improved outcomes across multiple outcome measures.(3) Our subsequent asthma programs have focused on dissemination and sustainability, with the incorporation of communication technology to enhance the system of care. We are currently testing the 'School-Based Telemedicine Enhanced Asthma Management' (SB-TEAM) program, including 400 children with persistent asthma from the Rochester City School District. This program includes directly observed administration of preventive asthma medication at school, and school-based telemedicine to assure appropriate evaluation, preventive medication prescription, and follow-up care. It is designed to implement and sustain guideline-based asthma care through existing community infrastructure, and could serve as a model for the integration of services in both rural and urban communities.

Is TAVR Ready for the Global Aging Population?

The emergence of the global pandemic of chronic diseases necessitates critical assessment of interventions that can be targeted at both the individual and population levels. Among cardiovascular diseases, the increasing prevalence of valvular heart diseases such as aortic stenosis parallels the rising burden of atherosclerotic cardiovascular diseases. As an alternative to surgical aortic valve replacement, technological innovation has allowed development of minimally invasive transcatheter aortic valve replacement (TAVR). This review examines whether TAVR can be applicable in low-resource regions across the world. Although revolutionary, TAVR is currently complex and requires a "Heart Team" approach for optimized patient care. We propose the emergence of telemedicine networks, newer valve designs that allow implementation of minimal approaches, and the use of minimal numbers of specialists for adapting TAVR to settings where surgical backup is not available. With efforts to reduce resource utilization, these alternate strategies have the potential to affect implementation of TAVR globally.

Headache patients' satisfaction with telemedicine: a 12-month follow-up randomized non-inferiority trial.

We investigated non-acute headache patients' long-term satisfaction with a telemedicine consultation and consultation preferences in northern Norway. We hypothesized that patients were not less satisfied with telemedicine than traditional consultations. We also examined the influence of gender, age and education on satisfaction.

Simulation Training: Evaluating the Instructor's Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training.

Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow's graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse.

Regional disparities in the quality of stroke care.

There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration.

Legal Mapping Analysis of State Telehealth Reimbursement Policies.

There exists rapid growth and inconsistency in the telehealth policy environment, which makes it difficult to quantitatively evaluate the impact of telehealth reimbursement and other policies without the availability of a legal mapping database.

Family Perspectives on Telemedicine for Pediatric Subspecialty Care.

Children often have difficulty accessing subspecialty care, and telemedicine may improve access to subspecialty care, but information is lacking on how best to implement telemedicine programs to maximize acceptance and, ultimately, maximize impact for patients and their families.

Commentary: A Breathing-Based Meditation Intervention for Patients with Major Depressive Disorder Following Inadequate Response to Antidepressants: A Randomized Pilot Study.

Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study.

Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management.

A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings.

To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites.

Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development.

Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management.

User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University.

Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users.

Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach.

To describe patient experiences and perspectives of a group-based heart failure (HF) telerehabilitation program delivered to the homes via online video-conferencing.

Delivering tertiary centre specialty care to ALS patients via telemedicine: a retrospective cohort analysis.

This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters.

Child and Adolescent Emergency and Urgent Mental Health Delivery Through Telepsychiatry: 12-Month Prospective Study.

The significant gap between children and adolescents presenting for emergency mental healthcare and the shortage of child and adolescent psychiatrists constitutes a major barrier to timely access for psychiatric assessment for rural and remote areas. Unlike remote areas, urban emergency departments have in-house psychiatric consultation. Telepsychiatry may be a solution to ensure the same service for remote areas. However, there is a paucity of studies on the use of telepsychiatry for child and adolescent emergency consults. Thus, the aim of our study was to (1) assess patient satisfaction with telepsychiatry and (2) compare clinical characteristics and outcome of telepsychiatry with face-to-face emergency child and adolescent assessments.

Pregnancy and the Acceptability of Computer-Based Versus Traditional Mental Health Treatments.

Recent recommendations urge increased depression screening in pregnant and postpartum women, potentially increasing demand for treatment. Computer-based psychotherapy treatments may address some of perinatal women's unique mental health treatment needs and barriers.

Unlocking the limitations: living with chronic obstructive pulmonary disease and receiving care through telemedicine - a phenomenological study.

The aim of this study was to describe the lived experiences of quality of life among a group of patients living with chronic obstructive pulmonary disease (COPD) who were included in a telemedical intervention after hospitalization for disease exacerbation.

First Step in Telehealth Assessment: A Randomized Controlled Trial to Investigate the Effectiveness of an Electronic Case History Form for Dysphagia.

The need for developing effective telehealth tools for dysphagia management is high not only for people who live in rural areas, but also for individuals with mobility/access limitations. We aimed to develop an electronic case History Tool/form (thereafter, e-HiT) for dysphagia, and compare its effectiveness with its paper-based version (PBV) on completion time, completeness, independence, and patient perceptions/satisfaction. Secondarily, we examined associations between the aforementioned variables and predictor variables, such as age, cognition, and computer/internet use. Forty adults who expressed concerns with eating/swallowing participated. To compare both versions, a randomized, controlled two-period crossover design was used. In Visit 1, Group A completed the e-HiT and Group B completed the PBV. In Visit 2, Group A completed the PBV and Group B completed the e-HiT. A satisfaction survey was completed post visits. There were no statistically significant differences for completion time (p = 0.743), completeness (p = 0.486), and independence (p = 0.738). Patient perception/satisfaction was significantly higher with the e-HiT (p = 0.004). In addition, a significant association was found between completion time and age (p = 0.0063). Our results indicate that completing the e-HiT is as time efficient as completing the PBV and that both forms elicit the same amount of information with no or minimal support. Also, completion of the e-HiT yielded significantly higher satisfaction responses. This is the first study documenting the effectiveness of the e-HiT for outpatients with dysphagia, providing evidence that the first step of a swallowing assessment-case history completion-can be effectively completed via telehealth by individuals with reliable internet connection and basic computer literacy skills.

Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes.

We studied a telemedicine intervention for persistent poorly controlled diabetes mellitus (PPDM) that combined telemonitoring, self-management support, and medication management. The intervention was designed for practical delivery using existing Veterans Affairs (VA) telemedicine infrastructure. To refine the intervention and inform the delivery of the intervention in other settings, we examined participants' experiences.

Developing the Safety Case for MediPi: An Open-Source Platform for Self Management.

mHealth and Telehealth technologies are increasingly used to provide personalised, interactive and timely access to health data, thereby helping patients take a more active role in their care process. However, similar to any intervention, the use of these technologies has to be assured to justify that they do not compromise patient safety. In this paper, we discuss the development of a safety case for MediPi; a research prototype for a low-cost open-source digital platform that collects physiological data from patients, at home, and makes it available to decision-support systems used by clinicians. We identify potential hazardous failures associated with the use of MediPi and examine current risk controls. We also explore the modular structure of the overall safety case of the platform. We conclude with a discussion of patient safety challenges related to the unsupervised nature of the care setting and the use of commercial off-the-shelf personal devices.

Design, Implementation and Operation of a Reading Center Platform for Clinical Studies.

Clinical reading centers provide expertise for consistent, centralized analysis of medical data gathered in a distributed context. Accordingly, appropriate software solutions are required for the involved communication and data management processes. In this work, an analysis of general requirements and essential architectural and software design considerations for reading center information systems is provided. The identified patterns have been applied to the implementation of the reading center platform which is currently operated at the Center of Ophthalmology of the University Hospital of Tübingen.

Target of obstructive sleep apnea syndrome merge lung cancer: based on big data platform.

Based on our hospital database, the incidence of lung cancer diagnoses was similar in obstructive sleep apnea Syndrome (OSAS) and hospital general population; among individual with a diagnosis of lung cancer, the presence of OSAS was associated with an increased risk for mortality. In the gene expression and network-level information, we revealed significant alterations of molecules related to HIF1 and metabolic pathways in the hypoxic-conditioned lung cancer cells. We also observed that GBE1 and HK2 are downstream of HIF1 pathway important in hypoxia-conditioned lung cancer cell. Furthermore, we used publicly available datasets to validate that the late-stage lung adenocarcinoma patients showed higher expression HK2 and GBE1 than early-stage ones. In terms of prognostic features, a survival analysis revealed that the high GBE1 and HK2 expression group exhibited poorer survival in lung adenocarcinoma patients. By analyzing and integrating multiple datasets, we identify molecular convergence between hypoxia and lung cancer that reflects their clinical profiles and reveals molecular pathways involved in hypoxic-induced lung cancer progression. In conclusion, we show that OSAS severity appears to increase the risk of lung cancer mortality.

Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record: A Pilot Study in a Safety-Net Public Health and Hospital System.

External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data. Epic EHR software (Epic Systems Corporation) is currently one of the most widely used EHR system in the United States, and development of a successful SAF workflow within it is needed.